The present invention generally pertains to intubation devices and more specifically to a method and a device for intubating a stoma.
A percutaneous endoscopic technique is known, as described for example in U.S. Pat. No. 4,795,430, whereby an illuminating fiber optic endoscope is inserted into a patient's mouth and advanced into the stomach. The stomach is then inflated with air and the position of the endoscope may be externally visualized by the illuminating tip of the endoscope. The abdominal and gastric walls are then pierced at the position of the endoscope and a stoma thereby formed. In order to intubate the stoma, one end of a suture thread is passed externally through the stoma, snared by the endoscope and drawn upward through the stomach, esophagus and out the mouth of the patient. The suture is then tied to the end of a specially prepared catheter equipped with a length of suture to permit the catheter to be tied to the one end of the suture extending from the patient's mouth. The catheter is then intubated by pulling it in a retrograde manner through the mouth, esophagus, and into the stomach and through the stoma.
The catheter described in the above-mentioned U.S. Pat. No. 4,795,430 comprises a multi-lumen enteral feeding tube having a retention cuff near the distal end thereof which serves as a retention member to prevent the tube from exiting the stoma. The retention cuff, which is inflatable and deflatable through the inflation lumen of the tube, is substantially filled with a resilient sponge-like porous material for maintaining the cuff in fully inflated position. At the one end of the tube is an elongated tapered sleeve which encloses the one end of the tube and passes the suture loop therethrough for use in intubating the catheter. The sleeve includes a skirt portion which creates a seal about a side port of the tube which permits air to escape from the inflation lumen but prevents the ingress of air into the inflation lumen. Prior to intubating the catheter into a patient, the surgeon or gastroenterologist performing the procedure must squeeze the cuff to expel air out of the cuff through the inflation lumen. After the tube has been positioned in the patient, a portion of the proximal end of the tube, including the sleeve and skirt are cut off, exposing the inflation lumen to ambient air and allowing air to enter the retention cuff.
The sleeve device described in the prior art patent is intended to act as a one-way valve to allow the escape of air from the inflation lumen and to prevent the ingress of air into the inflation lumen. Typically, in order to obtain a more complete deflation of the cuff, a syringe is inserted in the inflation lumen to evacuate the cuff and the inflation lumen. Steps must then be taken to assure that the vacuum is retained when the syringe is removed from the inflation lumen. The skirt of the sleeve or another device is installed to seal the inflation lumen. Such evacuation steps are awkward and unnecessarily prolong the intubation procedure. This procedure may also lead to repeated cuff evacuation steps. Of particular concern is the unexpected inflation of the retention cuff while in the esophagus. As a result, the patient experiences unnecessary trauma and the possibility of an emergency surgical procedure. Thus, a specific problem of the prior art lies in the collapsing of the cuff just prior to intubation and keeping the cuff in the collapsed state during the intubation procedure.